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described above are understood by the employer or union and are part of the agreement with each employer or union, including contract termination notification requirements.

60.1.8 – Medigap Guaranteed Issue Notification Requirements for Disenrollments to Original Medicare during an SEP – Part C only Social Security Act § 1882(s)(3)(D); 42 CFR 422.66(b)(3)(ii)

MA organizations are required to notify members of their Medigap guaranteed issue rights when members disenroll from the MA plan and into Original Medicare during a SEP. Model language discussing these Medigap rights has been provided in MA Exhibit 11 and MA Exhibit 12.

There may be cases when a Medigap issuer requires the beneficiary to provide additional documentation that they disenrolled as a result of an SEP and is eligible for such guaranteed issue rights. A beneficiary may contact the MA organization for assistance in providing such documentation. The MA organization may provide such a notice to the beneficiary upon request (see MA Exhibit 24).

60.2 – Required Involuntary Disenrollment 42 CFR §§ 422.74, 423.44(b)(2), and 423.44(e)

A CMS- or plan-initiated disenrollment, also referred to as involuntary disenrollment, is classified as either a required or optional involuntary disenrollment (§ 60.3).

An involuntary disenrollment is required, with certain exceptions, in the following circumstances:

• Enrollee no longer resides in the plan’s service area (including incarceration) (§ 60.2.1); • Part C Policy: Enrollee loses entitlement to either Medicare Part A or Part B (§ 60.2.2); • Part D Policy: Enrollee loses eligibility for Part D (§ 60.2.2); • Part C Policy: Enrollee loses special needs status and does not reestablish special needs plan (SNP) eligibility prior to the expiration of the period of deemed eligibility (see § 60.2.4 for more information on loss of special needs status); • Enrollee fails to pay Part D-IRMAA and CMS notifies the plan to effectuate disenrollment (§ 60.2.5); • Enrollee is not lawfully present in the United States (§ 60.2.6); • Plan’s contract is terminated, or has a service area reduction (§ 60.2.7); or • Part D Policy: Enrollee materially misrepresents information to the Part D sponsor regarding reimbursement for third party coverage (§ 60.2.8).

Generally, notices must be sent for disenrollments effectuated by plans. There are some CMS- initiated disenrollments where notice is required to be sent by plans and other CMS-initiated disenrollments where notice is not required but encouraged (see the chart below).